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S2 Case 6 - stroke & anticoagulation > Case Study: Anticoagulation > Flashcards

Case Study: Anticoagulation Flashcards

1
Q

What are the main uses of blood thinners?

A

Prevent thrombus formation in the venous circulation

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2
Q

What is prothrombin time used for?

A

DOACs
= blood test for thinning

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3
Q

What is INR used for?

A

Warfarin

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4
Q

What are the anticoagulants in the UK?

A

Warfarin
Apixaban
Rivaroxaban
Edoxaban
dabigatran

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5
Q

What do vitamin K antagonists do?

A

Inhibit the vitamin K dependent clotting factors

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6
Q

What are the vitamin K dependent clotting factors?

A

II
VII
IX
X

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7
Q

What is an example of a vitamin K antagonist?

A

Warfarin

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8
Q

What are the DOACs?

A

Apixaban
Edoxaban
Rivaroxaban
Dabigatran

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9
Q

What does Apixaban, Edoxaban + Rivaroxaban do?

A

Direct + reversible inhibitors of factor Xa

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10
Q

What does dabigatran do?

A

Reversible inhibitor of free thrombin

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11
Q

What are the risk factors of indication for DOACs?

A

Age >75 years
Hypertension
Diabetes
Symptomatic HF

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12
Q

What are the contraindications for DOACs?

A

Active bleeding
Acute stroke
GI bleeding
Intracranial bleeding
Family history

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13
Q

Which anticoagulant is there NOT a reversible agent for?

A

Edoxaban

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14
Q

What are the different monitoring requirements for Warfarin?

A

INR
TTR
Reassess suitability

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15
Q

Describe INR

A

Target range for indication

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16
Q

How often are INR done?

A

When newly on it
= every week

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17
Q

What is TTR?

A

Total time in range

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18
Q

What is the INR range for most things?

A

2.0-3.0

19
Q

What is the target INR for most things?

A

2.5

20
Q

What are the exceptions to the normal INR range?

A

Mechanical valves in mitral position
Anti-phospholipid Ab syndrome
= 2.5-3.5

21
Q

What do anticoagulation patients have to carry?

A

Yellow book
= shows drug, dose, monitoring

22
Q

What is INR NOT used for?

A

DOACs

23
Q

What monitoring for DOACs are required pre-treatment?

A

Baseline clotting screen
U&Es
LFTs
FBCs

24
Q

Why does kidney function need to be assessed before DOAC use?

A

Drugs renally excreted

25
Q

What assesses the risk of clotting?

A

CHA2DS2-VASc score

26
Q

What assesses the risk of bleeding?

A

ORBIT score

27
Q

What is the anticoagulation male score for CHA2DS2-VASc?

A

1 or more

28
Q

What is the anticoagulation female score for CHA2DS2-VASc?

A

2 or more

29
Q

What is in the CHA2DS2-VASc?

A

CHF = 1
Hypertension = 1
Age >75 = 2
Diabetes = 1
Stroke = 2
Vascular Disease = 1
Age 65-74 = 1
Sex (female) = 1

30
Q

What is the low risk ORBIT score?

A

0-2

31
Q

What is the medium risk ORBIT score?

A

3

32
Q

What is the high risk ORBIT score?

A

4-7

33
Q

What is in the ORBIT score?

A

Older age >74 = 1
Reduced haemoglobin = 2
Bleeding history = 2
Insufficient kidney function = 1
Treatment with antiplatelets = 1

34
Q

What are the advantages of DOACs?

A

Lower intracranial haemorrhage + stroke risk
Reduced monitoring
Fewer drug + food interactions
Less variable dosing

35
Q

What are the disadvantages of DOACs?

A

Higher cost
NO reversible agent for Edoxaban
Increased risk of GI bleed
Caution with renal impairment

36
Q

What are the advantages of Warfarin?

A

Lower cost
Easily reversed
Reputable history

37
Q

What are the disadvantages of Warfarin?

A

Frequent monitoring
Drug + food interactions
Variable dosing

38
Q

When do you NOT offer anticoagulation?

A

When patient aged under 65 with AF + NO risk factors other than their sex

39
Q

When does Warfarin need to be taken?

A

At night

40
Q

When does rivaroxaban need to be taken?

A

With food

41
Q

What do you counsel the patient about with Warfarin?

A

Don’t massively change your diet
= can affect INR score

42
Q

What should you never do if you miss a dose?

A

Double up on a dose

43
Q

What are some signs of bleeding?

A

Blood in urine or stool
Blood in sputum
Blood in emesis
Bleeding that not resolved or slowing within 10 mins

44
Q

What are some signs of clotting?

A

Chest or unilateral leg pain
SOB
Elevated HR (>100bpm)
Unilateral lower extremity swelling

S2 Case 6 - stroke & anticoagulation (7 decks)

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